PLEASE
READ THE FOLLOWING CAREFULLYBEFORE YOU SUBMIT THIS FORM ELECTRONICALLY.

1.
*Release from liability: I do hereby release
Capital City Dance Center
and its staff from any liability occurring on or around studio premises, or at any
function held at other locations in connection with the dance classes in
which the student named above is enrolled. I declare that the student named
above is in good health and can participate in dance education classes. Given the
nature of dance classes, and with the knowledge that injuries sometimes might occur, I
have taken the necessary steps to obtain accident, health, or hospitalization
insurance which would cover any sustained injury. In the event of an injury or emergency
when I cannot be contacted, I give my permission for you to obtain medical services
for the student named above.

2. *Authorization for enrollment: I authorize
Capital City Dance Center to enroll the
student
named on this form in dance classes, and I accept responsibility for the payment of
tuition for those classes for which the student is registered. I understand that
classes with an enrollment of less than six pupils are subject to cancellation.

3. *I understand that the curriculum fee for annual classes is non-refundable
and that there are no refunds or deductions for classes not attended.

4. *I understand that the Spring Performance fee is due with registration unless written notice that the student is not participating is received. I also understand that this fee is no longer refundable after December 20th and that we are committed to paying for recital costumes.

5.*I understand that I am obligated to pay the trimesters tuition if I do not give written notice of the
students withdrawal from classes by the 10th of the month in which tuition is due.